This may open the door to a conversation regarding how his substance use and misuse may progress to alcohol use disorder and its definition as a pattern of alcohol use leading to clinically significant problems, including increase in use, failed attempts to stop, and use leading to an impaired ability to meet role obligations (American Psychiatric Association, 2013). Current Drug Abuse Reviews, 4(1), 427. It allows for client individualization, use of a variety of strategies, ongoing assessment, and modifications as needed. Are mindfulness-based interventions effective for substance use disorders? 0000239101 00000 n The American Journal on Addictions, 21(1), 3846. 0000006666 00000 n Within the 'Presenting issues stage' its about looking at the current problems or issues the person is facing, to get a clear understanding of what they are and then set goals or targets based around this. She notably has a past history of childhood trauma and abuse. https://www.samhsa.gov/data/report/results-2016-national-survey-drug-use-and-health-detailed-tables An investigation of stigma in individuals receiving treatment for substance abuse. Cognitive Behavior Therapy (CBT) case conceptions have follows a 5p's model. The following pages describe two approaches to documenting the formulation using the 5Ps structure, including a narrative and flowchart. Diagnosis is not the same as formulation! This can be even more problematic given the lack of health care access for large numbers of Americans (Schoen, 2013). Etoom, Y., & Ratnapalan, S. (2014). B., Twohig, M. P., Waltz, T., Hayes, S. C., Roget, N., Padilla, M., & Fisher, G. (2007). Becks States that life experiences play a part in people dysfunctional beliefs and assumptions about themselves, others and the world around them (Beck 1967, 1979). McNeely, J., Kumar, P. C., Rieckmann, T., Sedlander, E., Farkas, S., Chollak, C., Kannry, J. L., Vega, A., Waite, E. A., Peccoralo, L. A., Rosenthal, R. N., McCarty, D., & Rotrosen, J. How to Write a Case Conceptualization: 10 Examples (+ PDF) Substance use and misuse also has a negative impact on intimate partners, such as assuming increased responsibility and navigating unpredictability (Hussaarts et al., 2012). Presenting problems are concerns that clients find difficult to manage. Morin, J.-F. G., Harris, M., & Conrod, P. J. (Goldman & Greenberg 1997). It can assist both novice and experienced clinicians working with clients who present for counseling with substance use and misuse. 0000180256 00000 n However, as mentioned previously, case formulations have been used across a variety of client concerns (Chadwick et al., 2003; Ingram, 2012; Persons et al., 2013). Substance Abuse and Mental Health Services Administration. He denies any significant increase in alcohol use or any other substance use. Dax presents as extremely frustrated and embarrassed at being mandated to attend counseling sessions. https://doi.org/10.3389/fpsyt.2013.00173 Belenko, S., Hiller, M., & Hamilton, L. (2013). 1189 0 obj <> endobj Mental health professionals evaluations of the Integral Intake, a metatheory-based, idiographic intake instrument. Clinical Pediatrics, 53(2), 111117. It's useful to employ the 5 Ps throughout the planning process. Lack of adaptive coping mechanisms resulted in using self-harm to cope and avoid further emotional dysregulation. Presenting Problem According to Read et. The last P looked at is Protective which as the name suggest looks at ways to prepare the client so that relapse is unlikely, this is done by looking at the strengths of the client as a platform to build on. May, R. (1950). The image (. What are the 5 Ps in psychology? - Alqatirat Keywords: substance use and misuse, Five Ps, idiographic, systematic, flexible. https://doi.org/10.1080/10826084.2017.1349800 To help treat the client with psychosis maintaining specific behaviour can be beneficial and help avoid frustration and upsetting experiences (Johnstone 2009). 0000180123 00000 n She subsequently planned to overdose on her medications. Current stressors, plus salient developmental history, The patient presents at this time with [problem and symptoms], in the context of [situation and stressors], Genetics, temperament, medical history, substances, medications, The patient has the following [genetic vulnerabilities, medical history], The patient grew up in a family characterized by [factors], with a caregiver who was [distant/available/invalidating], Capacity for interaction, communication, empathy, and attachment, The patient may have had difficulty in [stage of development], and this is reflected in [examples from adult relationships], It appears that the patient may have struggled with conflicts in early life. Liao, J.-Y., Huang, C.-M., Lee, C. T.-C., Hsu, H.-P., Chang, C.-C., Chuang, C.-J., & Guo, J.-L. (2018). Journal of Addiction Medicine, 11(1), 39. Health Education Journal, 77(7), 749761. Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust https://doi.org/10.3109/10826084.2013.770027 Diagram of Ray's 5Ps formulation (Johnstone & Dallos - ResearchGate In S. G. Hofmann & G. J. G. Asmundson (Eds. https://doi.org/10.1097/ADM.0000000000000260 They are. (2020, April 21). This may include a direct conversation about Daxs decision to drink, resulting in his becoming impaired, with the consequence of being detained, charged, and adjudicated. Her ongoing alcohol use is another example of a maladaptive coping strategy. BMC Medicine, 10(111), 13. What level of care is required (outpatient or inpatient)? PDF Using DSM-5 in Case Formulation and Treatment Planning of this manuscript. Harris, R. (2019). Moreover, the Five Ps align with SAMHSAs recommendation that clinicians tailor treatment to each client because no single treatment is particularly superior (SAMHSA, 2020). Treating complex cases: The cognitive behavioural. Use this table as a general guide, but don't memorize it for the sake of memorizing it! It can be changed and reviewed as the treatment is in progress if any new information come to light. We then move onto Perpetuating which looks at what factors are contributing to the remain of the problems the person is facing. 0000180034 00000 n Tahan, H. A., & Sminkey, P. V. (2012). (Johnstone & Dallos 2009). 0000186981 00000 n hTILSQ=HC@K(`$*P2C Ronald Press. Protective factors are those that help to moderate actual or potential substance use and misuse impact. Journal of Marital and Family Therapy, 38(1), 122144. The therapist provides a route easiest for the client by identifying methods that build on the clients current resilience and strengths. These symptoms have been further perpetuated by the personality factors and traits described above, and her ongoing financial stressors. Perpetuating Factors As you do more formulation, you will notice that patients tend to present in templates, that is, certain diagnoses tend to follow a certain common theme of predisposing, precipitating, and perpetuating factors. 0000238450 00000 n (2017, September 7). 0000011422 00000 n https://doi.org/10.1093/oxfordhb/9780199935291.013.57 Unlike summary, it is a discussion about alternative ideas about diagnosis, aetiology, treatment and prognosis and of the arguments for and against each alternative. The Five P's approach provides a structured way of constructing this formulation. 0000012631 00000 n https://doi.org/10.1016/j.psc.2010.04.012 However, each has some shortcomings. 0000155309 00000 n Persons, J.B., 1989. It may include past difficulties and experiences if these are relevant to the present. https://doi.org/10.1016/j.avb.2010.01.006 No plagiarism, guaranteed! Here's what the completed table would look like with the psychological factors incorporated. He was recently driving home from work in the evening and law enforcement stopped him because of erratic driving. Currently, there are a variety of empirically based interventions for treating clients who engage in substance use and misuse. Study for free with our range of university lectures! There are several approaches to managing client substance use and misuse that have demonstrated effectiveness. Professional Case Management, 17(4), 164172. Additionally, he reports significant stress and conflict in his marriage as well as concerns over some upcoming diagnostic tests for their daughter related to a heart murmur. and Clark, D.M., 1989. Rachman, S. and de Silva, P., 1978. https://doi.org/10.1377/hlthaff.2013.0879 0000011818 00000 n Johnstone & Dallos (2010) suggest a framework for CBT formulation which refers to the levels and process of formulation in regards to the five Ps; presenting issues, precipitating factors, perpetuating factors and protective factors presenting issues which define the current problems in term of emotions thoughts and . Having a framework for understanding of different psychological treatments and psychological theories can be helpful in making your psychological formulation flow intuitively (e.g. 0000016414 00000 n Based on what I have reviewed in this essay. Sample #1: Conceptualization for CBT case This is a 35-year-old Caucasian man referred by his physician for treatment of generalized anxiety. The CBHSQ report: Substance use and substance use disorder by industry. (2008). One or more perpetuating psychological processes: Chronic marital/relationship discord, lack of empathy from family/friends, developmentally inappropriate expectations. Current Drug Abuse Reviews, 8(1), 2640. Let's do a simplified formulation for the patient (Jane Doe) below. What it wants to Achieve. 0000015792 00000 n Clinical Psychology 5 P Case Formulation (Macneil et al., 2012) Your mindset for intervention should be geared towards CBT - in NHS IAPT services this would be 'your' approach along with assessment as part of your case formulation. OFarrell, T. J., & Clements, K. (2012). 5Ps Formulation | PDF | Substance Abuse | Mental Disorder The Five Ps is an idiographically based framework providing clinicians with a systematic and flexible means of addressing substance use and misuse that can be used in conjunction with standard substance use and misuse interventions. A review of CBT treatments for substance use disorders. She has the following protective factors, including a supportive psychiatrist and friend. The 4 Ps formulation table can be a very rigid and systematized way of presenting a formulation. Additionally, as it is a continuous process it allows the therapist to revise any incorrect hypothesis about any underlying mechanism at any stage. 1189 76 Substance use and misuse in the United States is extremely common. 0000199386 00000 n In spite of these limitations, there may be several potential areas of inquiry. Wiley. Treating substance use disorders in the criminal justice system. Engel, G. L. (1977). U.S. Department of Health and Human Services. As you get better and more expert at formulating, you may not need to use this rigid structured format, and instead, will be able to present a more intuitive and organic formulation of the patient instead (see other methods below). At its most basic, you could present each box sequentially and describe each factor. In fact, this stigmatization can come from those who are treating them (Luoma et al., 2007). Published data on those incarcerated appears to be several years old. Diagnostic and statistical manual of mental disorders (5th ed.). Drugs and drug policy: What everyone needs to know. 1264 0 obj <>stream It looks at situations both past and present which can be both experiences and distresses that lead to symptoms of a psychotic nature can lead to resolving the psychosis. What are perpetuating factors? In this article, we'll explore the 5 Ps in more detail and the tools that you can use in each area. Persons, J. Among those are 12-step programs (Humphreys et al., 2004), mindfulness-based interventions (Chiesa & Serretti, 2014), evidence-based approaches such as cognitive behavioral therapy (McHugh et al., 2010), and family counseling (OFarrell & Clements, 2012). Addressing the potential genetic link to substance use and misuse may prove beneficial in raising Daxs awareness (Dick & Agrawal, 2008). But the most important thing about formulation is that it should be intuitive and flow logically. hA 4-`76>m{dKs. What is a psychiatric case formulation? The emphasis here is on features that continue the presenting problem. Please refer to an authoritative source if you require up-to-date information on any health or medical issue. Correspondence may be addressed to Scott Peters, One University Way, San Antonio, TX 78224, scott.peters@tamusa.edu. (2003) noted, examining positive client experiences may be one way to discover how to increase client participation in substance use and misuse treatment. The more you formulate, it can be helpful to have a rough template of different formulations for different diagnoses (e.g. She experienced, Brief summarizing statement that includes demographic information, chief complaint, and presenting problems from patient's perspective and signs and symptoms (onset, severity, pattern), Integrative statement: how these factors interact to lead to the current situation and level of functioning, prognosis, and potential openings for intervention. Sancho, M., De Gracia, M., Rodrguez, R. C., Mallorqu-Bagu, N., Snchez-Gonzlez, J., Trujols, J., Snchez, I., Jimnez-Murcia, S., & Menchn, J. M. (2018). Previous studies using frameworks to formulate have often used cognitive behavioral therapy as the primary intervention (Chadwick et al., 2003; Persons et al., 2013). The biopsychosocial model considers the 4 Ps for each of the biological, psychological, and social factors: The 4 Ps can be laid out in a 3 x 4 table to systematically do formulation and identity factors. 0000007722 00000 n Case formulations have been used in a number of areas such as those with psychosis, anxiety, and trauma (Chadwick et al., 2003; Ingram, 2012; Persons et al., 2013). Is diagnosis enough to guide interventions in mental Karriker-Jaffe, K. J., Klinger, J. L., Witbrodt, J., & Kaskutas, L. A. If he cannot identify a time, simple role-plays in which Dax does not interrupt or yell and instead experiences different outcomes may provide optimism to Dax. American Psychiatric Association. It is likely that other clinicians presented with Dax would use a different combination of approaches. 5 Ps narrative table, from Comprehensive Care Resource Guide The essay will now look at the key ideas underpinning the process of CBT. The Essay Writing ExpertsUK Essay Experts. Routledge. Impact of case formulation in cognitive behaviour As part of his adjudication, Dax was required to attend five counseling sessions and have a clinicians report provided to the court. Novice clinicians, who often have a more limited repertoire of strategies, may find the Five Ps valuable because of its systematic framework to clients. Hypotheses are generated about the origins and causes of a patient's symptoms. Example of the 5 P's of Marketing John is considering operating a jet ski shop catering to travelers and tourists. Case Conceptualization - Psychology Tools The Five Ps does not adhere to any particular theoretical orientation, thus allowing for a greater repertoire of strategies to draw from to help clients with substance use and misuse. Many formulation models are administered within a cognitive behavioral grounding (Chadwick et al., 2003; Easden & Kazantzis, 2018; Persons et al., 2013). PDF Peters Case Formulation and Intervention Application of the Five PS If your specific country is not listed, please select the UK version of the site, as this is best suited to international visitors. https://doi.org/10.1111/j.1752-0606.2011.00242.x Mindfulness-based interventions for the treatment of substance and behavioral addictions: A systematic review. Self-help organizations for alcohol and drug problems: Toward evidence-based practice and policy. Societally, substance use and misuse consequences exceed $400 billion in crime, health, and lost productivity (U.S. Department of Health and Human Services, 2016, p. 2). Twelve-step attendance is most beneficial with inpatient substance use and misuse treatment (Karriker-Jaffe et al., 2018). Mintzberg's 5 Ps of Strategy - Developing a Better Strategy - Mind Tools